Health plans and TPAs
Health plans are insurance policies that private companies or government programs offer to cover healthcare costs for enrolled individuals. Third-party administrators manage and process insurance claims for these health and employee benefit plans, often serving as intermediaries among healthcare providers, payers and beneficiaries.
Top Stories
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News
04 Feb 2026
Nearly 45% of healthcare payments tied to APMs: Survey
The latest healthcare payments data shows stable participation in alternative payment models, although there was little growth in risk-based payments. Continue Reading
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News
21 Jan 2026
Medicare Advantage overpayments will total $76B this year: MedPAC
The federal government will pay an estimated $76 billion more to cover Medicare Advantage seniors this year than it would if those same seniors were in traditional Medicare, according to new estimates from an influential advisory group. Continue Reading
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Feature
13 Jan 2017
How Payers Can Improve HEDIS Quality Measure Performance
Population health management, health IT investment, and provider engagement need to be targeted to improve HEDIS quality measure performance. Continue Reading
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Answer
07 Oct 2016
How Medicare, Medicaid, and CHIP Guide the Health Payer Industry
Public coverage programs like Medicare, Medicaid, and CHIP are leading the way in value-based care payment models. Continue Reading
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News
05 Jul 2016
Why HEDIS Quality Measures Matter for Value-Based Care
HEDIS measures are being followed by public health payers that are moving into the value-based care sphere as well. Continue Reading
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News
30 Dec 2015
The History and Evolution of CHIP and the Medicare Program
When Lyndon B. Johnson took the presidency in 1964, the Medicare program was finally established as a system to provide healthcare coverage to elderly citizens around the nation. Continue Reading